Lower Gastrointestinal Bleeding

Bleeding from the lower part of the digestive system that appears as hematochezia (fresh blood, clot or cherry-coloured stool) or melena (dark-coloured tarry stool) is called lower gastrointestinal tract bleeding (lower GI bleeding) (or colonic bleeding). In the traditional definition, lower GI bleeding was generally classified as bleeding distal to the Treitz ligament (duodenojejunal junction) as the border. In the last decade, GI bleeding has adopted three categories in some recent publications: Upper, middle, and lower. According to this category, bleeding from a source between the Treitz ligament and the ileocecal valve is classified as middle GI bleeding, bleeding from the distal of the ileocecal valve is classified lower GI bleeding. Lower GI bleeding and hospitalization rates increase with ageing. Currently, physicians managing lower GI bleeding have many different diagnostics and therapeutic options ranging from colonoscopy and flexible sigmoidoscopy to radiographic interventions such as scintigraphy or angiography. Lower GI bleeding often stops spontaneously and less common than upper GI bleeding. Even though no modality has emerged as the gold standard in the treatment of lower GI bleeding, colonoscopy has several advantages and is generally considered as the preferred initial test in most of the cases.

Angiodysplasia of left colon extending to anal verge landed patient into APR: a rare finding

Angiodysplasias is a kind of vascular malformation preferably involves the veins. Angiodysplasia of colon is the second most common cause of lower gastrointestinal bleeding after diverticulosis. It usually involves caecum and ascending colon. Patient may either present with complaints of fresh bleeding per rectum or with melena. It usually occurs in elderly because of age related degeneration of small blood vessel walls. The case presented here involves a male patient of 25-year age with complains of intermittent bleeding per rectum and generalized weakness from one month. After examination it was found to have vascular ectasia involving mid transverse colon, left colon and the rectum coming down to anal verge which culminated into abdominoperineal resection. Biopsy of resected segment came to be angiodysplasia with external surface of specimen showing dilation of multiple vascular channels in entire length up to anal verge. This case report shows that though angiodysplasia is more common in old age but while exploring a young patient with lower gastrointestinal tract bleeding, and congestive changes are found in left colon possibility of angiodysplasia should also be kept in mind.

Endoscopic and angiographic management of lower gastrointestinal bleeding: Review of the published literature

Lower gastrointestinal bleeding is common and occurs often in elderly patients. In rare cases it is associated with hemorrhagic shock. A large number of such bleedings, which are often caused by colon diverticula, subside spontaneously. Alternatively they can be treated by endoscopic procedures successfully. Given the aging population of our society, the rising incidence of lower gastrointestinal tract bleeding and new anticoagulant therapies, some of the bleedings tend to be severe. Colonoscopy is the established standard procedure for the diagnosis and treatment of lower gastrointestinal bleeding. However, a small number of patients experience re-bleeding or shock; their bleeding does not resolve spontaneously and cannot be treated successfully by endoscopic procedures. In such patients, interventional radiology is very useful for the detection of bleeding and the achievement of hemostasis. Against this background we performed a literature search using PubMed to identify all relevant studies focused on the endoscopic and radiological management of lower gastrointestinal bleeding and present recent conclusions on the subject.